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honey-dewey · 3 years

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Gold in the Summertime

Pairing: Frankie ‘Catfish’ Morales/Reader

Word Count: 2,545

Warnings: Panic attacks, mentions of injury, stitches, and needles, but it’s mostly just that sweet sweet hurt/comfort

Permanent Taglist: @phoenixhalliwell @star-wars-hell

Very few good things ever happen at three AM in the Urgent Care. Let’s make a short list of things that will definitely not fall under the category of ‘good.’ 1) Having a patient who has apparently injured himself but refuses to tell you how. 2) Said patient hyperventilating and panicking until he actually breaks something because you tried to give him a tetanus shot. 3) The same patient’s three best friends yelling at you. 4) Singing to still the same patient to calm him down so you can stick him with a tiny needle so he won’t possibly die of tetanus.

A/N: The song that inspired this fic is actually a favorite of mine called ‘Gold in the Summertime’ by Matt Nathanson. Not required to read the fic, but it’s a cute song.

“Hey.”

“Oh hell no,” you said, turning to see your fellow night shift nurse, Tori, standing in the door of the break room. “No, I am not dealing with whatever drunken fool walked into that waiting room. It is three in the morning and I do not feel like screwing around right now.”

Tori raised an eyebrow. “Done?”

“Done,” you said, standing and preparing for the inevitable. “Who’s the patient?”

Tori handed you a file. You opened it, quickly scanning the information. F. Morales, forty two years old, in decent health, up to date with all his immunizations, served in the military, and was currently in the Urgent Care for a laceration on his left shoulder.

“How bad is it?” You asked, closing the file and following Tori to the waiting room.

“Eh,” she said with a shrug. “He isn’t gushing blood, so it’s not ER worthy. Probably just needs some stitches and a tetanus shot, depending on what got him.”

You blinked. “He didn’t say?”

Tori grinned. “Nope. Have fun.”

Groaning to yourself, you opened the waiting room door. “Morales?”

A man stood up, clearly the injured one in his group of friends due to the wad of cloth he was pressing to his left shoulder. “Yes?”

“Follow me,” you said, tucking the file beneath your arm. “So, what happened?”

The man grimaced. “Uh, I busted my shoulder.”

“How?”

The man was silent as you pushed open an exam room door and gestured him inside. “Well?”

“Well what?”

You sighed. “How’d you cut yourself?” You asked again, watching the man hop up on the exam table. You walked around to his back and slowly cut away the patch of his shirt that covered his shoulder. “And while you’re at it, you got a first name I could use, Mr. Morales?”

“Please just call me Frankie, most people do.”

“Most people?”

Frankie shifted as you examined the harsh tear in the skin. “My friends, those assholes outside, call me Catfish.”

You chuckled. “Military nickname?”

“Yeah.” Frankie winced as you pressed a finger against the wound.

A beat of silence, and then you had another question. “Is Frankie your legal name?”

“No, why?”

You smiled. “We need a legal name for the records.”

Frankie shrugged his uninjured right shoulder as you continued to evaluate the messy scrape on his left. “It’s Francisco. And that shit hurts.”

“Sorry,” you said, stepping back. “It needs a few stitches,” you decided. “But it isn’t horribly urgent so I’m gonna go grill your buddies outside to see if they’ll give me more answers about what happened.”

Frankie nodded, watching you leave.

“Would the party that escorted one Francisco Morales please follow me?” You asked, pushing open the waiting room door.

Three men stood up, and you led them down the hall a ways, so your conversation would be private. “Alright. Spill. He won’t tell me what happened.”

The man on the left snorted. “Unsurprising,” he said. “Fish is like a damn lockbox.”

“Benny,” the man in the middle hissed, nudging the man on the left. “Santi, you wanna take this? You saw it best.”

“Excuse you!” Benny objected. “I was there too!”

“You’re drunk.”

The man on the right, Santi, sighed. “Frankie got into a fight outside the bar we were at tonight. Some guy made a horrible comment about how women belong in the kitchen, I dunno, I didn’t hear that bit too well. But Frankie managed to win the fight with minimal injuries, right up until the guy’s equally shitty friend clipped his shoulder with a ripped in half beer can.”

You nodded, jotting notes down on Frankie’s file. “So what I’m hearing is that he was cut with a piece of likely filthy metal?”

“Yep.”

“Perfect,” You grumbled sarcastically. “You boys can head back to the waiting room. I’ll send him out when I’m done.”

The boys left, and you swung by the supply closet to grab a suture kit before heading back into Frankie’s exam room. “Still bleeding?”

Frankie looked up. “Yeah.” He had taken his hat off, fidgeting with the worn out brim. “Hurts.”

“I’ll bet,” you said, coming up behind him and gently taking his hand off the wound. “Gonna pop some stitches in, disinfect the hell out of this, then get your height, weight, the like, and send you off with a tetanus shot just for good measure. That old beer can probably doesn’t have any kind of illness, but we have to be sure.”

Frankie was silent, which wasn’t a good thing. You disinfected the wound, which sent him into a tailspin of hissed curses in your general direction, and before he realized what was happening, you were halfway done with the stitches.

“And that’s the last one,” you said, tying off the last stitch. “The stitches dissolve after a while, so you shouldn’t have to worry about coming back to get them removed. But do take care to change the bandages twice a day, and do not use this arm. I don’t care what you have to do, please do not rip these stitches.”

Frankie chuckled. “Yes doctor.”

Finishing up the bandage, you grinned at Frankie’s current shirt situation. “Do you want me to grab you a new shirt? I kinda ruined yours.”

“You did your job,” Frankie pointed out. “But yes, that would be nice.”

You ducked out of the room and grabbed a spare shirt from the nurse’s lost and found. “No one’s claimed this thing for almost eight months. I think the guy who owned it quit,” you said, handing Frankie the old Jack Daniels whiskey shirt. You watched him struggle to put it on, helping him a bit as the shirt got caught on his shoulder.

“Okay, follow me,” you said once Frankie was wearing a shirt again. He followed, just as asked, and you took his height and weight, texting both figures to Tori so she could prep a tetanus shot for you. In the meantime, you kept Frankie occupied, asking him questions about military things in the exam room.

“What’d you do in the military?”

“I was a pilot.”

“Planes?”

“Helos.”

“Fun. I’ve never been in a helicopter before. Those friends outside, are they?”

“Military friends? Yeah, mostly. I knew Santiago before all that though.”

A knock at the door interrupted your bonding session. Tori opened the door, holding a tray with the tetanus shot and a band-aid. “Sorry. Those shitty kids band-aids were all I could find.”

You shrugged. “Nah, it’s fine. I’m sure Mr. Morales won’t object to a Paw Patrol band-aid.”

However, as you turned back to Frankie, you realized he’d gone white as a sheet. “Frankie?”

Frankie shied away from you, despite you not moving. “Don’t,” he said, voice choked. “Please.”

Your heart squeezed at the desperation in his voice. He was very plainly terrified. “Frankie,” you repeated calmly, holding both hands up so he knew you were unarmed. “Hey, deep breaths.”

Frankie took a stuttering breath, and you sent a silent prayer out that he wouldn’t have a panic attack here. You sat next to him, keeping a few feet of space between you and him. “Do you want me to go get the boys?”

Frankie shook his head, eyes wide. You tried to think. Distracting him would do no good. You’d tried that before with other people, and with patients who were this panicky, a distraction made it worse. Trying to sneak up on him was somehow an even worse idea. With his background, he was likely to know when someone was trying to surprise him, and he could definitely defend himself. The only thing you could think of was calming him down and then sticking him as fast as you could.

It took a few minutes, but Frankie’s breathing returned to normal, and his muscles relaxed somewhat. You didn’t move, simply sitting there beside him and establishing yourself as a calm figure despite your reeling mind. “Frankie?”

He looked up at you, not saying a word.

“Are you ready to try?” You asked. “I have to give you the shot. I don’t want you to get sick, okay? Tetanus is a killer, and I don’t wanna see you dying in a hospital bed until you’re at least eighty, okay?”

A slow nod. You stood, making your movements obvious as you put on new gloves and opened an alcohol wipe.

“C’mere,” you said, gesturing Frankie closer. He scooted towards you, and you met him halfway. “This is cold, just a warning.”

You rolled up Frankie’s shirt sleeve, exposing his left shoulder. He shivered as you ran the alcohol wipe across his skin, and kept his eyes anywhere but on you as you uncapped the tiny syringe. “Frankie?”

Frankie whined, his breathing picking up again as his body barreled towards full panic mode.

“Frankie!” You recapped the syringe and set it aside, turning your full attention to Frankie. He jumped away from you, eyes wide once more. You stood back as he curled in on himself, breathing quickening too fast. He was hyperventilating. “Frankie! Listen to me! You’re not-“

You cut yourself off as the loud, ragged breaths began to turn into animalistic screams, Frankie losing his balance and falling off the exam table and crashing into the sink before hitting the floor. The thud his body made scared you, but not as much as his current panicked state.

“Tori!” You yelled, opening the door and yelling for your coworker. “Tori!”

Unfortunately, it was not Tori who came to your rescue. It was Frankie’s three friends, all of whom looked incredibly concerned. Tori was behind them, shouting that they couldn’t be back here. Santiago simply pushed past you and immediately rushed to Frankie’s side, the other two joining him as he attempted to console Frankie.

You, knowing your help wouldn’t be needed, tried to step away, but Santiago turned to call you back. “Come here!”

Sighing, you hesitantly entered the exam room. “What do you need from me?”

“What did you do to him?” Benny asked, clearly the most worried. “He hasn’t had an attack this bad in years!”

“I just tried to give him a tetanus shot!” You defended.

Santiago and the other man had gotten Frankie situated back on the exam table, sitting on his sides and keeping him upright as Benny rushed in and took his hands. “Fish? You with us buddy?”

Frankie, who had thankfully stopped screaming, whined. Benny smiled, squeezing his hands. “There’s our Fish. Hey, hey, no, look at me,” he directed as Frankie’s eyes drifted to you in the corner and his breath hitched.

Frankie’s head slumped against Santiago’s shoulder. He hummed uncomfortably, face scrunching as he shifted, trying to get comfortable.

“His shoulder,” you guessed softly. “Someone’s touching it.”

The man on Frankie’s right looked at his back. “Shit. Sorry Fish.”

Frankie sighed in relief and turned into pudding against Santiago’s shoulder. Benny still held his hands, humming softly. The other man, whose name you still didn’t know, stood and pulled you aside. “Hey. Did he tell you?”

“That he was trypanophobic?” You said, sliding your hands in your pockets. “No. But I figured it out pretty quickly when he went white as hell as soon as he saw the syringe. No one has a reaction this severe unless they have a phobia.”

The man nodded. “Yeah. Benny was right. Fish is kinda stubborn about these things. He hasn’t had an anxiety attack in years though. Sorry Benny gave you shit about triggering one. I know it wasn’t really your fault.”

“It was,” you mumbled, eyeing Frankie over the man’s shoulder. “It just wasn’t my intention.”

“Yeah.” The man looked back at Frankie. “Is the tetanus shot necessary?”

You nodded. “Unfortunately, yes.”

Santiago looked at you. “How good are you at singing?”

“I’m sorry?”

“It keeps him calm,” Santiago explained. “He used to sing to the helos whenever there was bad turbulence. Kept him level. We’d do it while you give him the shot, but none of us can sing.”

Frankie made a small, strangled noise, and you almost freaked out until Benny smiled and you realized Frankie was trying to laugh.

Smiling, you grabbed the syringe, a new alcohol wipe, and the band-aid. Santiago moved so he was sitting mostly behind Frankie, still supporting him. The other man, who you faintly heard Benny call Will, sat back on Frankie’s right. Benny took Frankie’s hands and stood to the side a bit so you would have room to work.

“Oh, let’s keep this going, I wanna go all in,” you sang softly, repeating some cute and catchy song Tori insisted on playing whenever she could. “We’ll never be lonely in the dark.” As you sang, you opened the alcohol wipe and cleaned a patch of Frankie’s shoulder.

“Rooftop in soho, Prince on the radio,” you kept going, uncapping the syringe and taking Frankie’s arm. “The city streets glow, gold in the summertime.” You quickly, between words, stuck Frankie and pressed down on the plunger. He whined, shying from the pain, but you just pressed the band-aid over the tiny puncture mark and kept singing. “Summertime, summertime, summertime, I gotta get that feeling.”

Gently taking Benny’s place, you stripped your gloves off and put your hands overtop Frankie’s. “You did good, Frankie,” you said. “C’mon, let’s get you out of here so the boys can take you home.”

Frankie wobbled to his feet, still nonverbal and a bit unsteady. You ended up needing a break in the waiting room, which was still empty. Giving Santiago a bottle of water for Frankie, you sat next to Frankie while the boys started the car.

You absently hummed the song from earlier, mostly to fill the stifling silence. As you reached the part you’d sung for Frankie, you noticed, with a small jolt, that he was humming along with you.

“You like the song?” You guessed, and Frankie nodded.

“Here.” You pulled a pen from your coat pocket and took his hand. “Give the whole thing a listen,” you said, scrawling down the name and artist of the song on Frankie’s hand. “And then call me,” you finished, adding your phone number below the writing.

Frankie smiled. “Meet cute,” he rasped, voice practically destroyed.

You laughed. “This is more of a meet ugly, but sure.”

Santiago came back, helping Frankie to his feet.

“See you again?” Frankie asked, voice still pretty shot.

“Hopefully not,” you said, holding the door open for Santiago. “At least, not here.”

Just like that, Frankie was gone.

That sunrise, as you settled into bed, you got a text from an unknown number.

Unknown Number: Song was super cute. Definitely adding it to my exercise playlist

You: Is this Mr. Morales?

Unknown Number: Just Frankie

Unknown Number was saved as Just Frankie

You: Okay Just Frankie. How’s your shoulder

Just Frankie: Hurts like a bitch, but I’ve had worse.

You: I’ll bet.

Just Frankie: Hey, wanted to ask you something

You: shoot

Just Frankie: do you always work nights?

You: not always, but mostly.

Just Frankie: cool. You free tomorrow at noon? I found this cool lunch place that has the best burgers ever

You: ever? I’ll have to see about that

Just Frankie: it’s a date then

You: It’s a date

#Triple Frontier #francisco 'catfish' morales #frankie morales #frankie morales x reader #frankie morales x you #Pedro Pascal #My writing

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lastbluetardis · 4 years

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The Real Story of How They Got Engaged

Summary: There are some stories that aren’t fit to be shared with the general public, but are fun memories to have nevertheless. Ten x Rose AU. 2100 words. Rated E. @doctorroseprompts

Prompt: voyeurism

As always, if you enjoy my fics, consider buying me a coffee?

AO3

Rose doesn’t mean to interrupt this, er, private moment. Honestly, she doesn’t. Her plan is to use the toilet, check on the baby, then make coffee and enjoy a lazy Sunday morning with her family. The baby’d had her and James up all night, thanks to teething and a recent bout of sleep regression; she’s sure James will appreciate a lazy morning cuddle on the couch. She can nurse the baby and he can make breakfast, then maybe they can play a video game or catch up on one of the thousand shows or films they’re behind on.

The clank of pipes and the water heater tells her that her partner is taking a shower, but she thinks nothing of it as she opens the door. Over the past three years of living together, they’ve seen each other utterly naked hundreds of times; it’s not uncommon for one of them to use the toilet while the other is showering.

Because of this, it takes Rose a few seconds to register what she’s seeing and hearing. A plume of steam greets her, as does the sound of pattering water and the vent fan. The frosted glass of the shower door is steamed up, but she can still see the lanky outline of James standing beneath the spray.

He has his head tipped back—not an unusual position for someone taking a shower. However, what catches her attention is the rest of his body. Specifically his arm, which is moving rather rhythmically in front of his hips. This is when her ears finally hear past the spray of water to pick up the muffled grunts and groans, noises she is all too familiar with.

Heat prickles across her skin, swooping low through her belly. She should turn around, let him have his privacy. But she’s rooted to the spot, her feet like lead weights holding her at the doorway to their bathroom.

His arm is moving faster now, and she can see it clearly in her mind’s eye. She can see the way he’s stroking himself, the way he adjusts his grip as his hand moves up and down, the way he gives the head a tight squeeze on the upstroke.

Her blood pounds between her legs, a delicious tingle she wants to address.

James lets out a curse and a moan, and Rose can’t hold back anymore. She has never moved so fast in her life, tugging off her sleep shirt and her knickers before she yanks open the shower door.

He lets out an unholy yelp, and, comically, grabs the flannel and holds it in front of his crotch. As though she’s never seen his cock before. As though she hasn’t spent the past minute watching and listening to him have a wank.

“Rose,” he squeaks, his voice several octaves higher than normal. He clears his throat but it doesn’t help. “What- what- what are you doing?”

“Sounded like my boyfriend was havin’ a bit too much fun without me,” she replies. “I didn’t want to miss out.”

She doesn't give him a chance to respond; she loops her arms around his neck and crashes her mouth to his. God, they need to do this more often, snog in the shower. The slick drag of his body against hers sets her nerves aflame with pleasure and desire and a desperation to be touched.

The wet thwack of the flannel hitting the shower floor is followed by his arms wrapping around her waist, hauling her closer. He is so hard at her belly, where he grinds helplessly against her.

“S-sorry,” he pants. “Didn’t mean to… I would’ve stayed in bed with you… fuck, but I woke up so hard and you were sound asleep.”

The sheer need in his voice sends a shiver down her spine, and she clamps her thighs together for any modicum of relief. And for as much as she wants to reprimand him, to tell him he could’ve woken her, she knows she probably would have refused his advances. With how little sleep she’s running on, she would’ve been furious with him for waking her.

“I wanna come,” he croaks, his hands a vice around her arse as he drags his hips up and down, in and out, pleasuring himself against her.

“Were you close?” she asks unnecessarily. With the sounds he’d been making and the somewhat frantic rhythm of his hips, she knows he was.

Still, he breathes, “God, yes.”

He lets out the most pathetic whimper she’s ever heard when she places her hands on his chest and gives him a small nudge. But he dutifully responds, and takes a step back. The heat and steam of the shower have nothing to do with the crimson tinge of his cheeks and neck.

He clenches his hands into fists as his toes grip the shower floor; she can almost see his body vibrating with tension, with the need to touch or be touched.

“Well, don’t let me stop you,” she drawls when he stands there, unmoving.

He blinks and cocks his head to the side. “I don’t understand. Don’t you want…?”

He gestures vaguely between his crotch and hers, and she swallows down a giggle. Instead, she explains, “Remember I nearly broke my arse the last time we tried to shag—properly shag—in the shower.”

“You didn’t break your arse,” he scoffs, rolling his eyes, but one of his hands has migrated between his legs to give attention to his hard, throbbing length.

“Nearly broke my arse,” she insists. “‘Cos you dropped me.”

“I didn’t drop you!” he splutters.

She bites her lip around a grin. Really, it had been entirely her fault, the incident she’s referring to. She had come so hard around him that when she arched her hips, her shoulders had had the leverage of the shower wall, and she’d accidentally pushed him off balance. They both overcompensated in an attempt to break their fall, but it had been no use. Though they each went crashing to the floor, she had higher to fall, thanks to him having been holding her up. Her tailbone had been bruised for weeks, and it took months for either of them to share a shower again.

But she loves teasing him about it, because he gets so adorably indignant. If you think about it, though, he was the one who had made her come so hard in the first place, which was what catalyzed the accident. So really, it was all his fault.

“Sure, love,” she says, blowing him a kiss. “Now, weren’t you in the middle of something?”

“Oh, yes,” he groans, and she can’t tell if it’s in response to her question, or the fact that his hand is moving up and down his cock again.

He moans, his eyelids fluttering shut as his hand works himself harder and faster. His chest heaves with his unsteady breaths, and he reaches out to brace his other hand against the wall. He’s hunched over now, his eyes squeezed shut and his jaw hanging open as he pants for breath.

God, he’s beautiful. She loves watching him lose himself in his pleasure. He so often makes sure to finish her off first before he comes that she almost always gets the chance to see him come undone.

“My James,” she whispers.

Slowly, she steps closer to him, not wanting to startle him or throw him off his rhythm, but wanting to touch him.

“Rose,” he rasps, the muscles of his throat working as his breathing stutters.

She wraps her arm around his waist, pressing herself into his side. She can feel the rhythm of his hand as he brushes against her stomach.

He pulls his other arm away from the wall to wrap around her waist. His fingers dig into her skin as he drops his forehead to her shoulder. She shivers as his breath tickles her damp skin.

Not much longer now, she thinks as his hand speeds up and the noises he’s making turn more urgent.

She bites her lip around an echoing moan when he cries out and comes against her belly. He’s shaking in her arms, gripping her so tightly as though she’s the only thing in the world keeping him upright.

She strokes any part of him that she can reach as he slowly comes down from his high, letting out involuntary sighs and shudders as he does. He is in no hurry to move, and in fact wraps both arms around her waist to hold her closer, keeping his face tucked into the side of her neck.

“I love you,” he mumbles, swaying them slowly from side to side. “Thank you. This was really nice… thank you.”

“Anytime,” she says, giving his waist a squeeze. “My turn?”

She can feel him smile into her neck. “Your turn. Do I get to watch?”

“‘Course.”

James pulls his face away from her neck and then slots his lips over hers. The kiss is soft and sweet, and though she would prefer something harder and more demanding, the brush of his mouth against hers his enough to stoke the fire swelling deep in her core.

But just as Rose is about to let her hand dip between her legs, she manages to hear a far-off wail. Groaning in frustration, she drops her head onto James’s chest.

“Babies. Such a cock block,” he quips. He kisses the top of her head. “I’ll take care of her. You finish your shower. And, er, finish yourself off too, if you’d like.”

“Oh, I was plannin’ on it.” What with how intensely she is throbbing with desire, there is no way she’s leaving this shower without an orgasm, thank you very much. “But you’re gonna miss the show.”

“I’m sure I can catch the encore later on,” he says with an over-the-top wink.

“If you’re lucky.” She leans up to press a firm, parting kiss to his lips. “Go on. Get the baby. And put the coffee on, would you?”

He snaps off a sharp salute. “Yessir.”

“That’s a good boyfriend,” she coos. “I’ve got you all trained up, don’t I?”

He grimaces. “I hate that word. Boyfriend. Makes it sound like we’re thirteen.”

“Well what else would you prefer me to call you?” Rose asks, a little impatiently. Their daughter was only getting louder, and she was still aroused beyond belief; staring at her soaking-wet gorgeous boyfriend was not helping. “Partner? Lover? Father of my child?”

“Well, husband seems like the next logical step,” he says.

And he’s said it so casually, it takes her brain a moment to catch up. Rose blinks once. Twice. But James is simply staring nervously at her.

“You did not just propose to me like that,” she says in disbelief.

“Well, if you don’t want to marry me, that's all you had to say,” he mutters, a little playfully but also a bit wounded.

They’ve discussed marriage before, plenty of times. And it was something they both agreed they probably wanted. But it has been well over a year since they last had the discussion, when they panicked that maybe they ought to get married before the baby came. They never really spoke about it so bluntly, though; it was usually the casual idea that they would end up married.

“James, you know I want to marry you,” Rose says, grabbing his arm before he can flee the room. “Of course I want to marry you. It’s something we always said we’d do, yeah?”

“Yeah,” he says, a small smile curving his lips. “So… does this mean we’re engaged?”

“No,” she says, and before his face can fall, she adds, “I want a proper proposal so I can actually tell people the story.”

“Well, this would make a funny story, wouldn’t it?” he muses.

She snorts. “How exactly would you like me to tell it? “Hi, Mum! Guess what? James proposed? Oh, how did it happen? Well, you see, I was visiting the toilet and heard him havin’ a wank so I joined him, and when we were finished, he popped the question. So romantic, isn’t it?” Yeah, I’m gonna pass on that.”

James lets out a laugh and admits, “Okay, yeah, that’s probably not the best story to share with our friends and family. Oh all right, Rose Tyler. You win. Guess I’ll save the ring for a later date.”

He winks at her and exits the shower, closing the frosted glass door behind him. He has already wrapped a towel around his hips and is walking out of the bathroom by the time the words sink in.

Horniness be damned, Rose yanks open the shower door and shrieks, “You have a ring?!”

#doctorroseprompts #ficandchips #dwfic #doctor who #ten x rose #ten x rose au #my fic #lemons #the real story of how they got engaged

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dinafbrownil · 4 years

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Analysis: In Medical Billing, Fraudulent Charges Weirdly Pass As Legal

Much of what we accept as legal in medical billing would be regarded as fraud in any other sector.

I have been circling around this conclusion for the past five years, as I’ve listened to patients’ stories while covering health care as a journalist and author. Now, after a summer of firsthand experience — my husband was in a bike crash in July — it’s time to call out this fact head-on. Many of the Democratic candidates are talking about practical fixes for our high-priced health care system, and some legislated or regulated solutions to the maddening world of medical billing would be welcome.

My husband, Andrej, flew over his bicycle’s handlebars when he hit a pothole at high speed on a Sunday ride in Washington. He was unconscious and lying on the pavement when I caught up with him minutes later. The result: six broken ribs, a collapsed lung, a broken finger, a broken collarbone and a broken shoulder blade.

The treatment he got via paramedics and in the emergency room and intensive care unit were great. The troubles began, as I knew they would, when the bills started arriving.

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I will not even complain here about some of the crazy-high charges: $182 for a basic blood test, $9,289 for two days in a room in intensive care, $20 for a pill that costs pennies at a pharmacy. We have great insurance, which negotiates these rates down. And at least Andrej got and benefited from those services.

What I’m talking about here were the bills for things that simply didn’t happen, or only kind-of, sort-of happened, or were mislabeled as things they were not or were so nebulously defined that I couldn’t figure out what we might be paying for.

To be clear, many of the charges that I would call fraudulent — maybe all of them — are technically legal (thanks sometimes to lobbying by providers), but that doesn’t make them right. And no one would accept them if they appeared on bills delivered by a contractor, or a lawyer or an auto mechanic. There were so many of these charges that I came up with categories to keep track of them:

1. Medical Swag

In the trauma bay, someone slapped a hard brace around Andrej’s neck until scans confirmed that he had not suffered a grievous spinal injury. It was removed within an hour.

The medical equipment company that provided that piece of plastic billed $319. Our insurer paid $215 (90% of its discounted rate of $239). We were billed $24, our “patient responsibility.”

Companies are permitted by insurers to bill for “durable medical equipment,” stuff you receive for home use when you’re in the hospital or a doctor’s office. That yields some familiar marked-up charges, like the sling you can buy at Walgreens for $15 but for which you or your insurer get a bill for $120 after it is given to you at urgent care. The policy has also led to widespread abuse, with patients sent home with equipment they don’t need: My mom’s apartment, for example, holds an unused wheelchair, a walker and a commode paid for by Medicare, by which I mean our tax dollars. It’s as if you were given a swag bag at a conference and then sent a bill for hundreds or thousands of dollars.

At least with swag, you get to keep it. My husband’s hardly worn neck brace didn’t even come home with us as a souvenir.

2. The Cover Charge

The biggest single item on Andrej’s ER bill was a $7,143.99 trauma activation fee. What was that for, since every component of his care had been billed and billed handsomely?

Among the line items: $3,400 for a high-level emergency room visit. $1,030 for the trauma surgeon. Between $1,400 and $3,300 for five purported CT scans. And I say “purported” because one trip into a scanner examined the head, upper spine and maxillofacial bones but was billed as three separate things. There was also an administration fee of more than $350 each for four injections.

Trauma activation fees have been allowed since 2002, after 9/11, when the Trauma Center Association of America, an industry group, convinced regulators that they needed to be compensated for maintaining a state of “readiness.”

Wait. Isn’t the purpose of an ER to be “ready”? Isn’t that why the doctors’ services and scans are billed at higher rates when they are performed in an emergency department?

Despite scrutiny from researchers about whether trauma fees are deserved, trauma activation fees have only grown in size, 15% annually in recent years, and can reach into the tens of thousands of dollars. (On average, Medicare pays a fee of about $1,000.) Some have likened trauma activation fees to a cover charge for being wheeled into an ER with major trauma. But does a cover charge typically cost more than the meal?

3. Impostor Billing

We received bills from doctors my husband never met. Some of these bills were understandable, like for the radiologist who read the scans. But others were for bedside treatment from people who never came anywhere near the bed to deliver the care.

Andrej had a small finger fracture with a cut that needed some stitches, which a resident, a surgeon-in-training, sutured. But the $1,512 billed came in the name of a senior surgeon, as if he had done the work.

Physicians and many other health professionals are allowed to bill for the work of “extenders” — stand-ins with less training who see patients and work under the supervising doctor. These might be residents, physician assistants or nurse anesthetists, for example. For billing purposes, this allows the senior providers to be in two, three, sometimes more than half a dozen places at once, often even when they are physically miles away.

The resident did a fine job on my husband. But if an assistant did the work, shouldn’t it be billed for less? At law firms, the hourly rates for paralegals and junior attorneys are lower than those for partners.

On a website called Clinical Advisor, a reimbursement expert himself seemed to wonder at the profession’s luck that such billing is tolerated: “I hear people ask, ‘How can I do that? The doctor never saw the patient, never had any interaction with the patient and yet I can still bill this service under the physician?’”

4. The Drive-By

The day before Andrej left the hospital, a physical therapist visited and asked a few questions. From that brief encounter, the therapist noted “ambulation deficits, balance deficits, endurance deficits, pain-limiting function, transfer deficits.” That translated into a bill of $646.15 for what was recorded as a P.T. evaluation “1st session only (billable).” He said he was there for 30 minutes, but he was not. He said he walked Andrej up 10 steps with a stabilizing belt for assistance. He did not. There was no significant health service given. Just an appearance and some boxes checked on a form. It’s a phenomenon called drive-by doctoring.

More shockingly, the drive-bys continued at our home, presaged by a call on Andrej’s cellphone a day after he was discharged. A physical therapist from a private company wanted to visit him for at-home therapy. In his discharge instructions, no one had mentioned this service, and his injury was clearly too fresh to benefit. She came. She didn’t know which body part had been injured and concluded he was in too much pain to participate.

The same company called twice more the following week to schedule visits. By the third time, I told Andrej not to open the front door. Nonetheless, our insurer was billed — and paid — for three visits.

It’s as if Alexa noticed that my dishwasher makes too much noise (it does) and took it upon herself to send over a repair guy. But if I turned him away at the front door, saying I’m OK with the racket (I am), would I still be billed for the visit?

5. The Enforced Upgrade

One Monday when Andrej was in pain and out of pills, the trauma doctor suggested we meet in the emergency room, because the trauma clinic was open only from 8 to 10:45 a.m. on Wednesdays and Thursdays.

So we met the trauma doctors in the ER, and they talked to Andrej, who remained in his street clothes. They gave him a prescription. Because the interaction — which could have happened in the lobby — happened in the ER, it resulted in an ER visit charge of $1,330. But when the trauma clinic is open less than six hours a week, billing for an ER visit that doesn’t tap into any of the emergency room resources feels like a scam. Is an ER visit determined by the content of the services rendered, or merely by the location?

Andrej had a similar experience when his broken finger was treated with a plastic splint that folded over his fingertip. He complained because the upper layer pressed on the fracture. At a follow-up visit, someone took a pair of scissors and cut off the upper half of the splint and taped the lower half back in place. That translated into a $481 charge for “surgery,” in addition to the $375 charge for the office visit and a $103 facility fee. Doesn’t surgery, by definition, involve cutting into flesh or an animate object — not a piece of plastic?

Sure, it sounds fancy to upgrade a meeting to an ER visit, or to call the tweaking of a splint “surgery,” but if an airline overbooks my flight and puts me on another flight where the only seat available is in first class, it does not charge me for the more expensive ticket.

My insurer paid for most of these questionable charges, though at discounted rates. But even a discounted payment for something that never really happened or didn’t need to happen or that we didn’t agree to have happen is still, according to common sense, a fraud.

Why do insurers pay? Partly because insurers have no way to know whether you got a particular item or service. But also because it’s not worth their time to investigate the millions of medical interactions they write checks for each day. Despite the advertised concern about your well-being, as one benefits manager enlightened me: They’re “too big to care about you.” Electronic records, which auto-fill billing boxes, have probably made things worse. For example, the birth of a baby boy may automatically prompt a bill for a circumcision; having day surgery may prompt a check for sedation.

So what is the appropriate payment for swag I didn’t ask for, outrageous cover charges, stand-in doctors, drive-by visits and faux surgery? In some cases, zero; in others, far less than was paid. And yet, these are all everyday, normal experiences in today’s health care system, and they may be perfectly legal. If we want to tame the costs in our $3 trillion health system, we’ve got to rein in this behavior, which is fraud by any other name.

from Updates By Dina https://khn.org/news/analysis-in-medical-billing-fraudulent-charges-weirdly-pass-as-legal/

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